Re “Wealthy, but not so healthy,” Editorial, Jan. 13

As you note, despite the presence of top-flight medical schools, welltrained doctors and nurses, extraordinary equipment, terrific medical research and 5,000 acutecare hospitals that are required to serve the entire population, the U.S. lags in mortality, morbidity and life expectancy versus other developed nations.

The answer to improvement rests not with our healthcare system but rather in addressing individual choices and accountability. Massive education initiatives on nutrition, exercise, lifestyle choices and wellness are needed if we are to make headway in improving Americans’ health. It will probably take at least another generation before we can accomplish the cultural shift needed.

In the meantime, we have a well-equipped and expensive healthcare system that will do little to improve our ranking in most health measures.

Rob Fuller

Downey

Your editorial points out the United States’ incongruous situation among “advanced” countries with its high healthcare costs and poor outcomes.

As Obamacare finally kicks in, a crucial weakness in our healthcare system will remain: Patients have easy access to quick medical evaluations and acute care when needed. Without a big increase in the number of primary-care doctors, the answer lies in training, licensing and promoting skilled primary caregivers who are not physicians but who can be accessed readily by patients.

We shouldn’t have to wait in a busy emergency room for an initial evaluation by a physician with 25 years of training who decides to send the patient home with aspirin and cough syrup.

Richard J. Steckel, MD

Santa Barbara